Avascular Necrosis (Osteonecrosis) of the Hip

Loss of Blood Supply to the Hip Bone Causing Joint Pain, Stiffness, and Bone Collapse.

Avascular necrosis (AVN), also known as osteonecrosis, is a condition in which the blood supply to the head of the femur (the ball of the hip joint) is interrupted or reduced. Without proper blood flow, the bone tissue begins to die, leading to the collapse of the femoral head and eventual joint damage. If left untreated, AVN can cause significant pain, hip joint dysfunction, and lead to severe arthritis. Early diagnosis and treatment are crucial to slowing the progression of the disease and preserving the hip joint.

CAUSES OF AVASCULAR NECROSIS

Avascular necrosis can develop from a variety of causes, although in some cases, the cause may be unknown (idiopathic).

Common causes of AVN include:

Trauma or Injury: A fracture or dislocation of the hip can damage the blood vessels supplying the femoral head, leading to AVN.
Long-term Steroid Use: Prolonged use of corticosteroids, often prescribed for conditions such as asthma or rheumatoid arthritis, can affect blood flow to the bones, increasing the risk of AVN.
Excessive Alcohol Use: Heavy drinking over an extended period can disrupt blood flow to the femoral head, leading to osteonecrosis.
Medical Conditions: Conditions such as sickle cell disease, lupus, and certain blood clotting disorders can increase the risk of AVN by affecting blood circulation to the bones.
Radiation Therapy or Chemotherapy: Treatments for cancer can damage the blood vessels in the hip, increasing the likelihood of AVN.

SYMPTOMS OF AVASCULAR NECROSIS OF THE HIP

The symptoms of AVN typically develop gradually, but as the condition progresses, they can worsen, impacting your ability to perform everyday activities.

Common Symptoms Include:

Hip Pain: Pain is often felt in the groin, thigh, or buttock and may initially only occur with weight-bearing activities, such as walking or standing.
Limited Range of Motion: As the condition progresses, you may experience stiffness in the hip, making it difficult to move or rotate your leg.
Limping: AVN can cause weakness in the hip joint, leading to difficulty walking or a noticeable limp.
Pain at Rest: In more advanced stages, the pain may persist even when you’re resting or sitting down.

DIAGNOSIS OF AVASCULAR NECROSIS

When you consult with Dr Liddell, he will perform a thorough physical examination of your hip, assessing your range of motion and pain level. He will also review your medical history and may ask about any risk factors associated with AVN.

Imaging tests are typically needed to confirm the diagnosis and determine the severity of the condition:

X-Rays: X-rays can show changes in the bone structure of the femoral head, particularly in the later stages of AVN when the bone begins to collapse.
MRI: An MRI is the most sensitive test for diagnosing AVN in its early stages, as it can detect changes in the bone before they are visible on X-rays.
Bone Scan: A bone scan may be used to assess the overall health of the hip joint and detect areas of reduced blood flow.

AVASCULAR NECROSIS TREATMENT OPTIONS

Treatment for AVN depends on the stage of the condition and the amount of damage to the hip joint.

NON-SURGICAL TREATMENTS

In the early stages of AVN, non-surgical treatments may help manage symptoms and slow the progression of the disease.

Common, non-surgical options for avascular necrosis of the hip might include:

Medications: Pain relievers, anti-inflammatories, and medications that improve blood flow to the bone may help manage symptoms and delay the progression of AVN.
Activity Modification: Reducing weight-bearing activities and using assistive devices, such as crutches, can help relieve pressure on the hip joint, reducing pain and slowing the damage.
Physiotherapy: A structured physiotherapy program can help maintain joint mobility and strengthen the muscles around the hip, providing better support to the joint.
Bisphosphonates: These medications, commonly used to treat osteoporosis, may help slow bone damage in early-stage AVN.

SURGICAL TREATMENTS

If AVN is advanced or non-surgical treatments are not effective, surgery may be necessary to prevent further damage to the hip joint or to restore function.

Surgical options for Avascular necrosis of the hip can include:

Core Decompression Surgery: In the early stages of AVN, this procedure may be performed to relieve pressure within the bone and improve blood flow to the affected area. During the procedure, Dr Liddell will remove a portion of the inner bone to reduce pain and stimulate healing.
Bone Grafting: In cases where core decompression is performed, a bone graft may be used to support the healing process. The graft helps promote new bone growth in the damaged area.
Osteotomy: This procedure involves reshaping the bone to take weight off the damaged portion of the femoral head, which can delay the need for a hip replacement.
Total Hip Replacement: In advanced stages of AVN where the bone has collapsed, a total hip replacement may be necessary to restore function and relieve pain. This involves replacing the damaged joint with an artificial implant.

Avascular necrosis is a serious condition that can lead to severe joint damage if left untreated. Early diagnosis and appropriate treatment are crucial to slowing the progression of the disease and preserving the hip joint. Dr Liddell will work with you to develop a treatment plan based on your specific needs and stage of the condition, with the goal of relieving pain and improving your quality of life.